Tubal ligation vs. Vasectomy-which is more common?

The more invasive tubal ligation still outnumbers vasectomy among the options for permanent sterilization for couples. The rationale for this involves speculation, but male partner anxiety surrounding issues of sexual function have been proposed and are certainly evident when counseling males before vasectomy.

Objective: To determine in an objective and quantifiable manner if vasectomy leads to a decrease in sexual frequency.

Design: The authors analyzed data from the National Survey of Family Growth (NSFG), which is a large survey of American households.

Methods: Data were extracted from 2 cycles of the NSFG (2002 and 2006-2008) and analyzed. Men were included if they were previously sexually active and were aged >25 years. Female partners were also surveyed in the NSFG and were included if they were between 25 and 45 years of age. Sexual frequency was compared between men (or male partners of female respondents) who had a vasectomy and those who did not. The database captured sexual intercourse frequency over the preceding 4 weeks.

Results: A total of 5838 men met inclusion criteria, with 353 of these having a previous vasectomy. Men who had a vasectomy engaged in intercourse at a mean rate of 5.9 times per month compared to 4.9 times in men who had not had a vasectomy (P =0.0004). Additionally, men who had a vasectomy were less likely to have not engaged in any sexual intercourse in the preceding month. In the survey of female partners, 5211 women responded regarding their male partners, and 670 partners had a previous vasectomy. Again, men with a previous vasectomy had a higher frequency of sexual intercourse during the previous month (6.3 vs 6.0), although this difference was not statistically different (P =0.1341).

Conclusions: Vasectomy does not appear to negatively influence sexual frequency.

Reviewer’s Comments: The more invasive tubal ligation still outnumbers vasectomy among the options for permanent sterilization for couples. The rationale for this involves speculation, but male partner anxiety surrounding issues of sexual function have been proposed and are certainly evident when counseling males before vasectomy. Previous reports have investigated if vasectomy has any effect on sexual function and satisfaction, with most finding minimal to no effect on sexual function. In fact, some reports have demonstrated improved sexual function with improved sexual satisfaction, likely due to the loss of anxiety about unwanted pregnancy. The authors of this article demonstrate through objective survey results that sexual frequency does not decrease and may increase with vasectomy. While no explanation can be extracted from these data, the results are encouraging and can certainly be mentioned while counseling men before vasectomy.(Reviewer–Charles Welliver, MD).